This study reviewed 78 cases of prostatic abscess at a hospital in Northern Territory, Australia over six years. Burkholderia pseudomallei (melioidosis) was the most common cause, present in 58% of cases. Patients with melioidosis-caused abscess tended to be younger, indigenous, and have more severe symptoms including systemic involvement and multifocal abscesses. They also had higher readmission rates, with 70% of readmissions being melioidosis patients. Overall the study found melioidosis-caused prostatic abscess requires more prolonged antibiotic treatment and monitoring than other causes to achieve cure and prevent readmissions.
This study reviewed 78 cases of prostatic abscess at a hospital in Northern Territory, Australia over six years. Burkholderia pseudomallei (melioidosis) was the most common cause, present in 58% of cases. Patients with melioidosis-caused abscess tended to be younger, indigenous, and have more severe symptoms including systemic involvement and multifocal abscesses. They also had higher readmission rates, with 70% of readmissions being melioidosis patients. Overall the study found melioidosis-caused prostatic abscess requires more prolonged antibiotic treatment and monitoring than other causes to achieve cure and prevent readmissions.
This study reviewed 78 cases of prostatic abscess at a hospital in Northern Territory, Australia over six years. Burkholderia pseudomallei (melioidosis) was the most common cause, present in 58% of cases. Patients with melioidosis-caused abscess tended to be younger, indigenous, and have more severe symptoms including systemic involvement and multifocal abscesses. They also had higher readmission rates, with 70% of readmissions being melioidosis patients. Overall the study found melioidosis-caused prostatic abscess requires more prolonged antibiotic treatment and monitoring than other causes to achieve cure and prevent readmissions.
Prostatic abscess in the Northern territory and the impact of Burkholderia pseudomallei:
Last six year review from the prospective database
Introduction & Objectives:
Patients presenting with prostatic abscess have declined due to the widespread use of antibiotics, however it still remains a difficult entity to treat. Over the years, prostatic abscess remains a common occurrence in the northern part of Australia especially owing to the organism Burkholderia pseudomallei. In the endemic southeast Asia and northern Australia, these prostatic abscess secondary to meloidosis occur predominantly in the wet season .In this study we aim to review the clinical presentation, management and short term outcome of prostatic abscess as also compare and contrast the abscess formed secondary to infection by Burkholderia pseudomallei. Methods: The study was conducted at the Royal Darwin Hospital, the tertiary referral hospital for the tropical north of the Northern Territory of Australia. A prospective database of all cases of prostate abscess were reviewed from July 2017 till July 2023. All the patients with a diagnosis of prostatic abscess confirmed on at least one radiologic imaging with a follow-up of at least 6 weeks were included. The clinic profile, diagnosis and management along with readmissions for prostatic abscess were noted. Patients with blood, urine or pus from prostatic aspirate which showed burkholderia pseudomallei on culture were included as a separate data set. Bivariate analysis was done between the melioid prostatic abscess and non melioid abscess cohort. All the data was the analyzed using SPSS 23 software. Results: Among the 78 patients diagnosed to have prostatic abscess, the most common organism was burkholderia pseudomallei (58.11%) followed by E. coli (32.11%) and staphylococcus aureus was the least common. Almost 83 %( 36/43) patients present with melioid prostatic abscess were indigenous. Table 1 shows the differences in clinical manifestation and short term outcome between melioid and non-melioid abscess of prostate. Sixty eight patients needed intervention either transrectal or transurethral drainage. Significant point to note was among the 24 readmission for prostatic abscess 17 (70%) were diagnosed melioidosis. Also 3 men needed more than 2 admissions in the melioid cohort. The most common reason for readmission in both groups was inadequate antibiotic treatment. The mean time to readmission however was 60.2 days in the melioid group as compared to 11.23 days in the other cohort. Table1. Stage at presentation between the indigenous and the non-indigenous population Prostatic abscess Melioid Other prostatic P value(<0.05 abscess(n=43) abscess(n=21) significant) Age at presentation 36.5 years 53.2 years 0.02 Indegenious population 36 6 0.032 Diabetes mellitus 37 19 NS Constitutional symptoms 40 21 NS Lower tract symptoms at 29 19 NS presentation Acute retention of urine 9 11 0.04 Hard prostate on 3 5 NS examination Prostatic tenderness 40 19 NS Multifocality of abscess 34 11 0.021 at presentation on imaging Systemic involvement 21 4 0.031 More than one drainage 6 3 NS procedure Readmissions 17 7 0.043 More than 2 3 0 0.00 readmissions NS= not significant Conclusions: As previously noted across the northern coast of Australia, the most common cause for prostatic abscess was melioidosis which is attributed to the bacteria being frequently found in the land and water of these regions. Young age at presentation with need for intervention including transurethral drainage in melioidosis worsens the quality of life especially due to retrograde ejaculation. Although direct associations and exact reasons are lacking, indigenous population is more predisposed to prostatic abscess due to burkholderia pseudomallei. The mean time to readmission, number of readmissions and multifocality of abscess indicate that unlike other prostatic abscess melioid abscess needs more prolonged treatment and close monitoring for more than 90 days post diagnosis. An integrated approach with early involvement of infectious disease specialist may help reduce the readmission rates and achieve cure for prostatic abscess.